The Center for Mental Health Services defines a serious mental illness as “mental illnesses listed in DSM that ‘resulted in functional impairment which substantially interferes with or limits one or more major life activities.” Thus, serious mental illness is a subset of the nearly-300 mental health diagnoses catalogued in the DSM-V, and includes schizophrenia, severe bipolar disorder, and severe, major depression.
Citing recent, horrific attacks in New York City in broad daylight, writer Charles Fain Lehman at the New York Post rightly recommends that the city begin exerting focused efforts on the seriously mentally ill rather than the broad swath of the mentally unwell.
The surge in violence by the seriously mentally ill is a major threat to public safety in the city. But the city’s leadership would prefer to focus on mental-health care in general, distracting from the few mentally ill people who are the real cause of public fear.
This was the main effect of Mayor de Blasio’s ThriveNYC program, which aimed to convince New Yorkers that everyone is at risk for mental illness. That meant scarce resources are spread widely, rather than focused on the most disruptive. …
Such violent incidents may not be the most common manifestations of mental illness, but they are happening with alarming frequency in the city. And they are what most concerns everyday New Yorkers, who want to walk the streets of Manhattan unafraid of madmen attacking them.
To deal with the problem, focus less on the mental-health needs of the many, and more on those of the few.
Lehman is right, and he’s supported by the late DJ Jaffe. Writes Jaffe in his 2017 book Insane Consequences:
Poor mental health is not the same as mental illness or ‘serious’ mental illness. One hundred percent of the US population has at some point felt sad, anxious, or nervous and therefore could be considered as having poor mental health. But only 18 percent of the population over eighteen (forty-three million adults) had a mental illness in the past year, and only 4 percent (ten million adults) had a serious mental illness. Our community programs largely help the 100 percent who can have their mental health improved, or the 18 percent with any mental illness, but rarely focus on the 4 percent with serious mental illness.
Psychiatry and mental-health care have the potential to relieve much suffering if utilized carefully. Writes Stephen Eide at the Wall Street Journal, “Somewhere around 500,000 severely mentally ill people are either institutionalized, incarcerated or homeless. Unless we’re going to tell such vulnerable people to snap out of it and get a job, psychiatry has a place in American society.”
We already have the tools. All that is needed is a good and clear aim.